Joint Commission Elevates Nursing Leadership

In October 2025, The Joint Commission announced a new performance goal for hospitals. Beginning January 1, 2026, nurse staffing will be officially recognized as a core component of quality and safety 1. The goal is to ensure that the correct patient receives the correct care at the correct time.2 The Joint Commission recognizes nurses as core to organizational safety. This reinforces that safety is a priority in every nurse hiring decision. And while it is not mandated, thorough background screening and identity verification can help to establish a nurse’s qualifications and credentials.

Nursing leadership’s role in improving the hiring processes

As The Joint Commission moves nurse staffing into the lens of quality performance, leaders might realize that simply having enough nurses is no longer sufficient. The metric is rising: the right number of nurses with the right credentials, verified, monitored, and ready to deliver safe care.

Identity, background screening and verification solutions matter because:

• Identity fraud or misrepresentation of credentials implies a number of different risks to a health care organization
• Licenses, certifications and backgrounds may contain sanctions, exclusions, or disciplinary actions. 3
• A strong credentialing process supports accreditation, licensing and regulatory compliance, especially as staffing becomes a quality metric.
• Efficient onboarding and verification support retention, speed to bedside, and mitigate the risk of uncovered gaps that may lead to audit findings.

The remit for nursing leaders goes beyond scheduling and supervision. Diligent leaders will also own the process to help qualify that each nurse deployed is the correct individual, with a validated identity, a valid license, a clean background and the right skills.

Key responsibilities for nursing leaders

For a nursing leader stepping into this new leadership role, here are some core responsibilities to be embraced:

• Define policy: Set clear verification standards for identity, credentials, licensure, background checks, and ongoing monitoring.
• Provide oversight: Assign accountability for verification workflows, data tracking, expiration management and audit-readiness.
• Partner with stakeholders: Work with HR, credentialing office, vendor partners, and compliance and nursing education teams.
• Drive continuous improvement: Review efficiency, turnaround times, verification failures or red flags, and refine the process.
• Communicate the importance: Help staff understand why verification is mandatory, how a lack of verification can imply potential risk to patient safety, and how verification supports staffing quality metrics (e.g., those driven by The Joint Commission).
• Monitor metrics: Track verification completion rate, time-to-bedside for new hires, credential expiration compliance, and audit findings.
• Embed it all in culture: Make verification part of orientation, ongoing clinical competency and shift readiness.

Ways to improve identity verification

For nursing leaders who may want to improve identity verification as part of their responsibilities, we offer the six-step process below to help get nurse verification is right.

Step 1: Verify identity

Begin by confirming the individual’s identity. This may seem obvious, but verifying that the person applying is indeed who they claim to be is essential. This is a frequently overlooked risk.

Key actions:

• Require government-issued ID and verify via digital or in-person check.
• Leverage remote identity verification tools (biometric, facial recognition, mobile) to enhance speed and consistency.
• Cross-reference identity data with subsequent credential and background checks to promote a consistent name, date of birth, and SSN (or equivalent) match consistently.
• Store identity verification records in a central system tied to the nurse’s profile.

By front-loading identity verification, nursing leaders will help mitigate the risk of later mismatches, erroneous credential links, or identity fraud.

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Step 2: Credential, license and certification verification

Verify that the nurse holds a valid license (e.g., RN, LPN), certifications (e.g., BLS, ACLS), and educational credentials.

Key considerations:

• Verify license validity through state nursing boards or national databases.
• Confirm certifications and expiration dates, and track continuing education compliance.
• Confirm educational credentials, as needed, particularly for advanced practice roles.
• Document verification results and flag credentials that are soon to expire for proactive renewal.

Step 3: Background, exclusion and sanction screening

Background checks help screen for criminal records, sex offender registry listings, and exclusion lists, and are essential for vetting nursing candidates.

Key considerations:

• Screen against national criminal records databases, state criminal court records, sex offender registries, abuse/neglect registries, and, when applicable, foreign jurisdictions for international hires.
• Check federal and state exclusion lists (e.g., OIG, GSA) for individuals prohibited from participation in federal healthcare programs.
• Incorporate drug and health screenings where required, as well as verification of immunizations or health clearances if required by your facility or state.
• Maintain a clear adjudication policy: what level of offense disqualifies, what level triggers further review, and how to handle ongoing monitoring.

Step 4: Centralization and workflow integration

All these verification steps should not exist in silos. For an efficient, audit-ready process, centralize verification data and integrate it with staff onboarding and deployment workflows. We recommend central records, renewal alerts, and linking credentialing to scheduling.

Key considerations:

• Use a credentialing system or partner platform that stores all verification results, license status, expiration dates, and renewal alerts.
• Link credential-status to staffing systems. Consider only engaging staff with verified credentials and no unresolved red flags as eligible for assignment.
• Set automated alerts to the nursing leader or the credentialing manager before key credentials expire.
• Periodically audit the system to cross-check for missing renewals, expired certificates, identity mismatches or process bottlenecks.

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Step 5: Ongoing monitoring and continuous verification

Verification is not a one-and-done step. Licenses expire, new sanctions may appear, and credentials may lapse. A robust program includes ongoing tracking.

Key considerations:

• Establish periodic re-checks of licenses and certifications (e.g., annually or biannually) as part of your credentialing policy.
• Monitor exclusion or sanctions lists continuously (or batch daily/weekly) to be made aware of any new actions.
• Track staff mobility (float, travel nurses, per diem) and check each shift assignment meets credential requirements.
• Maintain audit-trail logs and reports for leadership review, compliance, and accreditation readiness.

Step 6: Reporting, metrics and leadership oversight

Nursing leaders need to translate verification efforts into actionable oversight and reporting, especially given that staffing is now tied to quality metrics under The Joint Commission standards.

Key metrics to track:

• Percentage of new nurses with completed identity, as well as credential and background verification, before their first shift.
• Average time from offer to verified ready to badge/board status.
• Number of credential exceptions or mismatches discovered and resolved.
• Number of licensure or certification expirations that occurred without renewal.
• Staffing pool eligibility: number of nurses eligible vs assigned.
• Audit findings related to staffing and credentialing (internal or external).

By regularly reporting to senior leadership, nursing leaders position verification as a foundation for safe staffing rather than simply an HR task.

Moving Forward

The landscape of nursing staffing is shifting. With The Joint Commission elevating nurse staffing to a formal performance goal, healthcare leaders, and especially those new to nursing leadership roles, are now required to don a broader hat. It’s not just about scheduling and team management. Good leadership takes the necessary steps to check that every nurse hired is who they say they are. This requires verification, accountability and continuous readiness.

By partnering with a dedicated vendor like First Advantage, nursing leaders gain access to tools, dashboards, metrics and support that allow them to focus on quality staffing rather than process firefighting.